Provider Demographics
NPI:1316361124
Name:ROBINSON, DWAYNE (CATC II)
Entity Type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:CATC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 BUSINESS CENTER DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3447
Mailing Address - Country:US
Mailing Address - Phone:909-804-8877
Mailing Address - Fax:909-885-6852
Practice Address - Street 1:1845 BUSINESS CENTER DR STE 106
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3447
Practice Address - Country:US
Practice Address - Phone:909-804-8877
Practice Address - Fax:909-885-6852
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAB5983996101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program